------------------------------
/ OMB APPROVAL /
/------------------------------/
/ OMB Number 3235-0362 /
/ Expires: February 1, 1994 /
/ Estimated average burden /
/ hours per response...... 1.0 /
/------------------------------/
+--------+ U. S.
| FORM 5 | SECURITIES AND EXCHANGE COMMISSION
+--------+ Washington, D.C. 20549
[_] Check box if
no longer subject ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
to Section 16.
Form 4 or Form 5 Filed pursuant to Section 16(a) of the Securities
obligations may Exchange Act of 1934, Section 17(a) of the
continue. See Public Utility Holding Company Act of 1935 or
Instruction 1(b). Section 30(1) of the Investment Company Act of 1940
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
--------------------------------------------------------------------------------
1. Name and Address of Reporting Person
Fredricks Mark J
----------------------------------------------------------------------------
(Last) (First) (Middle)
c/o Lakeland Bancorp, Inc.
250 Oak Ridge Road
----------------------------------------------------------------------------
(Street)
Oak Ridge New Jersey 07438
----------------------------------------------------------------------------
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol Lakeland Bancorp, Inc.
-----------------------------------
3. IRS or Social Security Number of Reporting Person
(Voluntary) 154-62-7287
--------------
4. Statement for Month/Year 12/31/00
---------------------------------------------------
5. If Amendment, Date of Original (Month/Year) Dec-99
--------------------------------
6. Relationship of Reporting Person to Issuer (Check all applicable)
[X] Director [_] Officer [_] 10% Owner [_] Other
(Title Below) (Specify Below)
1.34%
-----
-------------------------------------------------------------------------------
Table 1 -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
------------------------------------------------------------------------------------------------------------------------------------
1. Title of Security 2. Trans- 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature
(Instr. 3) action action or Disposed of (D) Securities Form: of Indirect
Date Code (Instr. 3, 4, and 5) Beneficially Direct Beneficial
Lakeland Bancorp, Inc. (Month/ (Instr. 8) Owned at (D) or Ownership
Day/ End of Indirect (Instr. 4)
Year) Issuer's (I)
(A) or Fiscal Year (Instr. 4)
Amount (D) Price (Instr. 3 and 4)
------------------------------------------------------------------------------------------------------------------------------------
Common 02/15/00 DRP 104 A $12,5000 I *6
------------------------------------------------------------------------------------------------------------------------------------
05/15/00 DRP 119 A $11,1100 I *6
------------------------------------------------------------------------------------------------------------------------------------
08/15/00 DRP 113 A $11,7100 I *6
------------------------------------------------------------------------------------------------------------------------------------
11/15/00 DRP 131 A $10,9200 I *6
------------------------------------------------------------------------------------------------------------------------------------
11/15/00 S/D 174 A I *6
------------------------------------------------------------------------------------------------------------------------------------
11/15/00 S/D 716 A I *6
------------------------------------------------------------------------------------------------------------------------------------
11/08/00 G 250 A 19077 I *6
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
------------------------------------------------------------------------------------------------------------------------------------
FORM 5 (Continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
M. Fredricks (e.g., puts, calls, warrants, options, convertible securities)
-----------------------------------------------------------------------------------------------------------------------------
1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv-
Security (Instr. 3) sion or action tion Code ative Securities
Exercise Date (Instr. 8) Acquired (A) or
Price of (Month/ Disposed of (D)
Deriv- Day/ (Instr. 3, 4, and 5)
ative Year)
Security
---------------------------
(A) (D)
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
6. Date Exer- 7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na-
cisable and Underlying Securities of of Deriv- ship ture
Expiration (Instr. 3 and 4) Deriv- ative of De- of In-
Date ative Secur- rivative direct
(Month/Day/ Secur- ities Secu- Bene-
Year) ity Bene- rity: ficial
(Instr. 5) ficially Direct Owner-
-------------------------------------------- Owned (D) or ship
Date Expira- Amount or at End Indi- (Instr. 4)
Exer- tion Title Number of of Year rect (1)
cisable Date Shares (Instr. 4) (Instr. 4)
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
-------------------------
*6 - Mark J. Fredericks custodian for William Fredericks, under NJUGTMA, son of
Mark J. Fredericks
CODES:
DRP - Dividend Reinvestment Plan
S/D - Stock Dividend
G - Gift
/s/ Mark Fredericks 01/26/01
------------------------------- -----------------
**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 7811(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.